Assistant Professor, Pediatric Critical Care Medicine and Cardiology Texas Children's Hospital, Baylor College of Medicine HOUSTON, Texas, United States
Abstract:
Introduction: The role of methyl prednisolone (MP) in improving inflammation related to new ventricular assist device (VAD) implantation has not been extensively studied in the current era. The association of MP with trends of inflammatory markers and pump exchange has not been described.
Methods: We performed a single center retrospective cohort study of all patients < 21 years old placed on durable VAD support from 12/2019 to 12/2021. Demographic and clinical information abstracted included MP course duration, laboratory markers of hemolysis and inflammation at weekly intervals and peri-MP course (lactate dehydrogenase (LDH), plasma free hemoglobin (plasma Hb), C-reactive protein (CRP), fibrinogen), and need for pump exchange.
Results: Thirty two patients (53% male, median age 7yr) underwent durable VAD support (14 pulsatile flow, 18 continuous flow) during the study period. Etiology of heart failure included cardiomyopathy in 60%, single ventricle congenital heart disease (CHD) in 27%, and biventricular CHD in 13%. Type of VAD included 44% Berlin EXCOR, 34% Heartware HVAD, and 22% Heartmate3. Pump exchange occurred in 19% (6/32). Nineteen patients (59%) received at least 1 course of MP (1mg/kg/dose twice a day) during VAD support, with 3 patients receiving 2 courses and 1 patient receiving 3 courses. MP was started a median of 8 days into VAD support (IQR 7 – 11 days). Median duration of primary MP course was 4 days (IQR 3 – 5days). Among patients receiving MP, there was a significant reduction in CRP and fibrinogen values over the course of MP, however no change in the hemolysis markers (Table 1). There was no association of MP course with age, sex, weight, height, etiology of HF, or type of VAD flow (Table 2). We did not find a statistical difference in LDH, plasma Hb, CRP or fibrinogen at 7, 14, and 21 days after VAD implant between patients who did or did not receive MP (Table 3). Patients who received MP tended to have a higher daily rate of rise of fibrinogen in the first 7days after VAD implant, as well as a greater daily rate of decline of fibrinogen in the 2nd and 3rd weeks of VAD implant, although not meeting statistical significance. Patients receiving MP also tended to have a greater proportion undergoing pump exchange, although not statistically significant.
Conclusion: Over half of the patients undergoing durable VAD support received a course of MP which was effective in reducing CRP and fibrinogen. Patients receiving MP tended to have a faster rate of decline of fibrinogen in the 2nd and 3rd weeks of VAD support compared to those not receiving MP. Larger studies are needed to assess the impact of MP course on VAD complications.
